Cervical approach for percutaneous needle biopsy of Pancoast tumors.

Aspiration needle biopsy techniques have simplified the cytohistological diagnosis of peripheral pulmonary lesions, particularly those close to or involving the chest wall. In the past, the inaccessibility of some Pancoast tumors in the thoracic inlet posed difficulty in obtaining histological proof before combined therapy was instituted, except in the case of large apical tumors. A safe and accurate technique for percutaneous needle biopsy of tumors in the superior pulmonary sulcus using a cervical approach has been developed. We have found that this technique is easy to perform and more productive for small or shallow lesions at the extreme apex than are needle biopsies performed through a posterior approach, and that it makes open biopsy unnecessary.

Small cell carcinoma of the lung: results of combination chemotherapy and radiation therapy.

A retrospective study of 244 patients treated for small cell carcinoma of the lung from Jan 1, 1971 to Dec 31, 1976 revealed that 34% of patients, with local-regional disease who received radiation alone survived one year (median survival, seven months), and 53% with local-regional disease survived one year (median survival, 12 months) when treated with combination chemotherapy and radiation. The one-year survival for patients presenting with metastatic disease was 14.5% (median survival, five months) when treated with radiation alone and 50% (median survival, 11 months) when treated with combination chemotherapy and radiation. Although combination chemotherapy and radiation will prlong the disease-free interval in patients with small cell carcinoma of the lung, more than 90% will develop evidence of progressive disease within two years.

Long-term survival after resection for bronchogenic carcinoma.

Of 915 resections for bronchogenic carcinoma over a 25-year period (1945-1969), 249 patients survived over 5 years; 127 of the patients eligible survived over 10 years, 61 over 15 years, and 22 over 20 years. The case material was divided into three time periods: 1945-49, 1950-59 and 1960-69, as well as by extent of resection. Lobectomy became the operation of choice, pneumonectomy being reserved for the more extensive lesions. Observed survival rates at 5, 10 and 15 years for 561 patients in the lobetomy series were 35, 22 and 15%, respectively, but strikingly increased to 41, 28 and 19% in the 1960-69 period. Observed rates for 354 patients having pneumonectomies were similar for three time periods, being 16, 8 and 6% at 5, 10 and 15 years, respectively. Relative survival rates for the lobectomy series at 5, 10 and 15 years rose from 33, 28 and 26%, repectively, in the 1950-59 period to 50, 39 and 35% in the last time period, becoming a near horizontal curve segment after 5 years. Dominant factors in survival were extent of the lesion and stage of nodal involvement, histologic type and location being less significant.

Pulmonary giant cell carcinoma.

Pulmonary giant cell carcinoma is one of the most highly malignant neoplasms of the lung. Eighteen patients with this tumor are presented. Histologically the neoplasm is composed of a preponderance of multinucleated giant cells, round cells, and spindle cells. Some of the most differentiated tumors show adenocarcinomatous foci and ultrastructural features of secretory epithelium favoring its classification as a variant of pulmonary adenocarcinoma. The giant cells of this neoplasm can be differentiated from those encountered in undifferentiated large cell carcinoma and epidermoid carcinoma by the abundant cytoplasm, the presence of more nuclei and nucleoli, and the significant degree of phagocytosis. The clinical picture and roentgenographic findings present no pathognomonic features.

Reoperation for recurrent thoracic outlet syndrome.

Recurrent thoracic outlet syndrome that requires reoperation accounts for 1% of first rib resections. Symptoms in a series of 30 patients were mainly neurological and consisted of pain and paresthesia involving the neck, shoulder, arm, and hand and were severe and unrelenting. Recurrence of symptoms ensued from one month to seven years following initial rib resection, with the majority appearing within the first three months. Nerve conduction velocities were diminished to an average of 51 m per second, well below the normal of 72 m per second. Reoperation was required after a period of extensive physiotherapy and muscle relaxants. The high posterior thoracoplasty approach is recommended for all reoperations, as it gives better exposure to achieve safe neurolysis of the plexus and complete excision of the regenerated periosteum and posterior rib remnant, which were present in almost all patients. Results of reoperation were gratifying, and postoperative nerve conduction velocities were improved to an everage of 66 m per second.

Carcinomas in the superior pulmonary sulcus.

Carcinomas in the superior pulmonary sulcus produce a clinical pattern peculiar to their location. Pancoast (1932) defined tumors in this precise location and described a characteristic group of clinical findings now known as the Pancoast syndrome. Experience with a total of 92 patients with primary carcinomas in the superior pulmonary sulcus treated by combined preoperative irradiation and extended resection in 61 patients (66 per cent) reveals 16 of 46 patients eligible surviving over 5 years (34 per cent) and eight of 30 patients alive over 10 years (29 per cent). Stage of nodal involvement, extent of the tumor, cell type, and pathological effects of preoperative irradiation in the resected specimens are the important factors in prognosis.